Relationship of HIV care engagement to emergency department utilization

Abstract

To determine if HIV primary care engagement (PCE) is associated with Emergency Department (ED) utilization, a retrospective cohort study using the South Carolina HIV surveillance data from January 1986 to December 2006 linked to the hospital discharge data-set was used to assess utilization at statewide EDs during January 2007-December 2010. Suboptimal PCE was defined as <2 reports of a CD4 + T-cell count or viral load value to surveillance in each calendar year from January 2007 to December 2010. Multivariable logistic regression explored associations of HIV PCE with ED utilization after accounting for sociodemographic characteristics and disease stage. Poisson and negative binominal regression examined PCE, sociodemographic characteristics, and disease stage on the frequency of ED utilization. Suboptimal PCE was associated with increased odds of ED utilization for NIR/NRR (no identified risk/no risk reported; aOR [adjusted odds ratio] = 2.25; CI = 1.69-2.99), self-payers (aOR = 1.81; CI = 1.38-2.39), and those diagnosed with an AIDS-defining illness (ADI; aOR = 1.51; CI = 1.14-2.00), who also had the most median ED visits (six). More ED visits were associated with young age, female (incidence rate ratio [IRR] = 1.16; CI = 1.06-1.27), ADI (IRR = 2.17; CI = 1.93-2.45), Medicaid recipients (IRR = 1.34; CI = 1.21-1.49), indigent/charity recipients (IRR = 1.86; CI = 1.57-2.21), or AIDS > 1 year (IRR = 1.23; CI = 1.13-1.35). Fewer visits to the ED were associated with MSM (males having sex with males IRR = 0.81; CI = 0.72-0.90), NIR/NRR (IRR = 0.86; CI = 0.78-0.95), self-payers (IRR = 0.56; CI = 0.50-0.62), or Medicare recipients (IRR = 0.85; CI = 0.77-0.95). Disease stage and insurance type were differentially associated with primary care and ED utilization. There is a need to evaluate HIV primary care systems to increase access and develop interventions to reduce preventable ED visits.

Emergency department use by people with HIV in Ontario: a population-based cohort study

“…12,13 Although subse quent studies found persistently heightened rates of emer gency department use following the introduction of com bination antiretroviral therapy, inferences were limited by samples that were small and not populationbased. 7,9,10 A recent analysis of the US National Hospital Ambulatory Medical Survey demonstrated that rates of emergency department visits among people with HIV continue to exceed those of noninfected people (633 v. 438 visits per 1000 people), although by a smaller magnitude than during the preceding decade. 14 Analogous populationbased studies characterizing emer gency department use among people with HIV in a Canadian setting are lacking.…”

“…Yet, in contrast to studies examining inpatient and out patient health care use, [2][3][4][5][6] comparatively few contemporary studies exist examining emergency department use among people with HIV. [7][8][9][10][11] Studies conducted in the years pre ceding the introduction of combination antiretroviral ther apy demonstrated that people with HIV had rates of emer gency department visits that were three to fourfold higher than those of the general population. 12,13 Although subse quent studies found persistently heightened rates of emer gency department use following the introduction of com bination antiretroviral therapy, inferences were limited by samples that were small and not populationbased.…”

Assessing Health Care Equity Through Administrative Data-Derived Qquity Indicators and Socio-Economic Determinants of Health in Emergency Care: A Systematic Review

“…(1) ED visits/Emergency admissions rate With 26% (n = 7) of articles using this indicator, it was the most commonly reported indicator identi ed in this systematic review. (32)(33)(34)(35)(36)(37)(38) It was used to highlight disparities of access to outpatient care. Since both re ect poor access to quality primary care, we have grouped them under the same indicator.…”

“…(2) Ambulatory care sensitive conditions (ACSCs) ED visits/ACSCs emergency admissions rate Also called Preventable ED visits/Preventable emergency admissions, this indicator, used in seven articles, is used as often as the previous indicator "ED visits/Emergency admissions rate". (8,33,35,(39)(40)(41)(42) It is deemed a more speci c indicator than "ED visits/Emergency admissions" alone to assess disparities in access to outpatient care.…”

Measuring health equity in emergency care using routinely collected data: a systematic review

“…We categorized them into four groups according to the part of the patient care pathway they analysed, (1) ED visits/Emergency admissions [1] rate With 26% (n=7) of articles using this indicator, it was the most commonly reported indicator identi ed in this systematic review. (23)(24)(25)(26)(27)(28)(29) It was used to highlight disparities of access to outpatient care. Since both re ect poor access to quality primary care, we have grouped them under the same indicator.…”